<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01//EN"
        "http://www.w3.org/TR/html4/strict.dtd">
<html>
<head>
       	<meta http-equiv="content-type" content="text/html; charset=utf-8">
       	<title>{PAGE_TITLE}</title>	
       	<style type="text/css">
			/*margin and padding on body element
			  can introduce errors in determining
			  element position and are not recommended;
			  we turn them off as a foundation for YUI
			  CSS treatments. */
			body {
				margin:0;
				padding:0;
			}
		</style>
	
	<!-- fonts -->
			<link rel="stylesheet" type="text/css" href="{absRoot}lib/YUI/yui/build/fonts/fonts-min.css" />
	<!-- fonts -->
	
	<!-- DMS style sheet -->				
			<link rel="stylesheet" type="text/css" href="{absRoot}css/dms.css" />
	<!-- DMS style sheet -->
	
	<!-- Xajax initialization code -->
		{XAJAX_INIT}
	<!-- Xajax initialization code -->			
			
</head>
<body class="yui-skin-sam">       					
	<div class="referral_window">				
		<div class="font_small" style="padding-right:15px;"><span class="font_bold">First Name:</span><input type="text" id="referred_donor_firstname" /> </div>
		<div class="font_small" style="padding-right:15px;"><span class="font_bold">Last Name:</span><input type="text" id="referred_donor_lastname" /> </div>
		<div class="font_small" style="padding-right:15px;"><span class="font_bold">Phone:</span><input type="text" id="referred_donor_phone" /></div>
		<div class="font_small" style="padding-right:15px;"><span class="font_bold">Mobile:</span><input type="text" id="referred_donor_mobile" /></div>
		<div class="font_small" style="padding-right:15px;"><span class="font_bold">Email:</span><input type="text" id="referred_donor_email" /></div>					
	</div>
	<div style="clear:both;"></div>	
</body>
</html>
